Case Report: A Case of Severe Clinical Deterioration in a Patient With Multiple Sclerosis.
demyelinating disease
immunocompromised multiple sclerosis patient
multiple sclerosis
multiple sclerosis rebound
progressive brain lesions
tumefactive multiple sclerosis
Journal
Frontiers in neurology
ISSN: 1664-2295
Titre abrégé: Front Neurol
Pays: Switzerland
ID NLM: 101546899
Informations de publication
Date de publication:
2020
2020
Historique:
received:
17
05
2020
accepted:
25
06
2020
entrez:
25
9
2020
pubmed:
26
9
2020
medline:
26
9
2020
Statut:
epublish
Résumé
Tumefactive multiple sclerosis (MS) is a rare variant of MS that may lead to a rapidly progressive clinical deterioration requiring a multidisciplinary diagnostic workup. Our report describes the diagnostic and therapeutic approach of a rare and extremely severe course of MS. A 51-year-old man with an 8-year history of relapsing-remitting MS (RRMS) was admitted with a subacute progressive left lower limb weakness and deterioration of walking ability. After extensive investigations including repeated MRI, microbiological, serological, cerebrospinal fluid (CSF) studies, and finally brain biopsy, the diagnosis of a tumefactive MS lesion was confirmed. Despite repeated intravenous (IV) steroids as well as plasma exchanges and IV foscarnet and ganciclovir owing to low copy numbers of human herpesvirus 6 (HHV-6) DNA in polymerase chain reaction (PCR) analysis, the patient did not recover. The clinical presentation of tumefactive MS is rare and variable. Brain biopsy for histopathological workup should be considered in immunocompromised patients with rapidly progressive clinical deterioration with brain lesions of uncertain cause.
Identifiants
pubmed: 32973648
doi: 10.3389/fneur.2020.00782
pmc: PMC7461937
doi:
Types de publication
Journal Article
Langues
eng
Pagination
782Informations de copyright
Copyright © 2020 Breitkopf, Aytulun, Förster, Kraus, Turowski, Huppert, Goebels, Hefter, Aktas, Metz, Brück, Reifenberger, Hartung and Albrecht.
Références
J Clin Virol. 2012 Feb;53(2):151-5
pubmed: 22133730
JAMA Neurol. 2018 Apr 1;75(4):428-435
pubmed: 29404583
J Infect Dis. 1994 Apr;169(4):943-4
pubmed: 8133119
Proc Natl Acad Sci U S A. 2010 Mar 23;107(12):5563-8
pubmed: 20212114
Ther Adv Neurol Disord. 2015 Sep;8(5):233-8
pubmed: 26557898
J Neurol Sci. 2017 Jun 15;377:112-115
pubmed: 28477677
Brain. 2008 Jul;131(Pt 7):1759-75
pubmed: 18535080
Mult Scler. 2012 Nov;18(11):1650-2
pubmed: 23100527
Trends Mol Med. 2001 Mar;7(3):115-21
pubmed: 11286782